<div>
  <div class="row">
    <div class="col-lg-12">
      <div class="ibox">
        <h3 class="m-t-none m-b ">修改随访登记</h3>
        <div class="ibox-content">
          <div>
            <div>
           
              <div class="form-group row">
                <label class="col-sm-2 col-form-label">随访时间</label>
                <div class="col-sm-6">
                  <input v-model="editGovFollowupSurveyInfo.surveyTime" type="text" placeholder="必填，请填写随访时间"
                    class="form-control">
                </div>
              </div>
              <div class="form-group row">
                <label class="col-sm-2 col-form-label">人口ID</label>
                <div class="col-sm-6">
                  <input v-model="editGovFollowupSurveyInfo.govPersonName" type="text" placeholder="请选择客户"
                    class="form-control">
                </div>
                <button class="col-sm-1 btn btn-primary float-right" type="button" v-on:click="_openAddChooseGovPersonModel()"><i
                  class="fa fa-check"></i>&nbsp;选择</button>
              </div>
              <div class="form-group row">
                <label class="col-sm-2 col-form-label">随访方式</label>
                <div class="col-sm-6">
                    <select class="custom-select" v-model="editGovFollowupSurveyInfo.surveyWay">
                      <option selected value="">请选择随访方式</option>
                      <option value="1001">门诊</option>
                      <option value="2002">家庭</option>
                      <option value="3003">电话</option>
                  </select>
                </div>
              </div>
              <div class="form-group row">
                <label class="col-sm-2 col-form-label">症状</label>
                <div class="col-sm-6">
                    <div class="checkbox custom-control-inline" v-for="(item,index) in govFollowupSurveyManageInfo.govSymptomTypes" >
                      <label>
                          <input type="checkbox" v-model="editGovFollowupSurveyInfo.symptomsSel"
                          :value="item.symptomId">{{item.name}}
                      </label>
                  </div>
                </div>
              </div>
              <div class="form-group row">
                <label class="col-sm-2 col-form-label">生活方式指导</label>
                <div class="col-sm-6">
                    <textarea v-model="editGovFollowupSurveyInfo.lifeStyleGuide" placeholder="必填，请填写生活方式指导"
                    class="form-control"></textarea>
                </div>
              </div>
              <div class="form-group row">
                <label class="col-sm-2 col-form-label">服药依从性1001规律</label>
                <div class="col-sm-6">
                    <select class="custom-select" v-model="editGovFollowupSurveyInfo.drugCompliance">
                      <option selected value="">请选择服药依从性</option>
                      <option value="1001">规律</option>
                      <option value="2002">间断</option>
                      <option value="3003">不服药</option>
                  </select>
                </div>
              </div>
              <div class="form-group row">
                <label class="col-sm-2 col-form-label">药物不良反应</label>
                <div class="col-sm-6">
                    <select class="custom-select" v-model="editGovFollowupSurveyInfo.adrs">
                      <option selected value="">请选择药物不良反应</option>
                        <option value="0">无</option>
                        <option value="1">有</option>
                    </select>
                </div>
              </div>
              <div class="form-group row">
                <label class="col-sm-2 col-form-label">随访分类</label>
                <div class="col-sm-6">
                    <select class="custom-select" v-model="editGovFollowupSurveyInfo.surveyType">
                      <option selected value="">请选择随访分类</option>
                      <option value="1001">控制满意</option>
                      <option value="2002">控制不满意</option>
                      <option value="3003">不良反应</option>
                      <option value="4004">并发症</option>
                  </select>
                </div>
              </div>
              <div class="form-group row">
                <label class="col-sm-2 col-form-label">用药情况</label>
                <div class="col-sm-6">
                    <textarea v-model="editGovFollowupSurveyInfo.medication" placeholder="必填，请填写用药情况"
                    class="form-control"></textarea>
                </div>
              </div>
              <div class="form-group row">
                <label class="col-sm-2 col-form-label">转诊原因</label>
                <div class="col-sm-2">
                  <input v-model="editGovFollowupSurveyInfo.referralReason" type="text" placeholder="必填，请填写转诊原因"
                    class="form-control">
                </div>
                <label class="col-sm-2 col-form-label" style="text-align: end;">转诊机构及科别</label>
                <div class="col-sm-2">
                  <input v-model="editGovFollowupSurveyInfo.referralDepartment" type="text" placeholder="必填，请填写机构及科别"
                    class="form-control">
                </div>
              </div>
              <div class="form-group row">
                <label class="col-sm-2 col-form-label">随访建议</label>
                <div class="col-sm-6">
                    <textarea v-model="editGovFollowupSurveyInfo.surveyAdvice" placeholder="必填，请填写随访建议"
                    class="form-control"></textarea>
                </div>
              </div>
              <div class="form-group row">
                <label class="col-sm-2 col-form-label">随访结论</label>
                <div class="col-sm-6">
                    <textarea v-model="editGovFollowupSurveyInfo.surveyConclusion" placeholder="必填，请填写随访结论"
                    class="form-control" ></textarea>
                </div>
              </div>
              <div class="form-group row">
                <label class="col-sm-2 col-form-label">下次随访时间</label>
                <div class="col-sm-6">
                  <input v-model="editGovFollowupSurveyInfo.nextSurveyTime" type="text" placeholder="必填，请填写下次随访时间"
                    class="form-control editNextSurveyTime">
                </div>
              </div>
              <div class="form-group row">
                <label class="col-sm-2 col-form-label">随访医生</label>
                <div class="col-sm-6">
                  <input v-model="editGovFollowupSurveyInfo.surveyDoctor" type="text" placeholder="必填，请填写随访医生"
                    class="form-control">
                </div>
              </div>
              <div class="form-group row">
                <label class="col-sm-2 col-form-label">备注</label>
                <div class="col-sm-6">
                    <textarea v-model="editGovFollowupSurveyInfo.remark" placeholder="选填，请填写备注"
                    class="form-control"></textarea>
                </div>
              </div>

              <div class="ibox-content">
                <button class="btn btn-primary float-right" type="button" v-on:click="editGovFollowupSurvey()"><i
                    class="fa fa-check"></i>&nbsp;保存</button>
                <button type="button" class="btn btn-warning float-right" style="margin-right:20px;"
                  data-dismiss="modal" v-on:click="_closeEditGovFollowupSurvey()">取消</button>
              </div>
            </div>
          </div>
        </div>
      </div>
    </div>
  </div>
</div>